| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | wcApp | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | issApp | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624073733.994-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 12462 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 3123 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Richardson | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Russell | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Clint | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Billington | |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20150415 | |
| PID.8 | Administrative Sex | M | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 1002-5 | |
| PID.10.2 | Text | American Indian or Alaska Native | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 543 Blount Drive | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5557690 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 07 | |
| PD1.11.2 | Text | Recall only - no calls | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | N | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20150415 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Richardson | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Maria | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | MTH | |
| NK1.3.2 | Text | Mother | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 543 Blount Drive | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5557690 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 2 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Richardson | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | John | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | William | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | FTH | |
| NK1.3.2 | Text | Father | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 543 Blount Drive | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | CP | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5558299 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 3140 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 38766 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 8681 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 65138 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 7491 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 79539 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 9077 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 31528 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 299 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 82668 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49281-0560-05 | |
| RXA.5.2 | Text | Pentacel | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 526434 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150722 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4047-20 | |
| RXA.5.2 | Text | RotaTeq | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 2.0 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 297961 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150916 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00005-1971-01 | |
| RXA.5.2 | Text | Prevnar 13 | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 353480 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150729 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150416 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | Hep B, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150515 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | Hep B, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38288 | |
| RXR.1.2 | Text | Oral | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | ||
| RXR.2.2 | Text | ||
| RXR.2.3 | Name of Coding System | ||
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | ||
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | ||
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Russell Clint Richardson |
| Mother's Maiden Name | Billington |
| ID Number | 3123 |
| Date/Time of Birth | 04/15/2015 |
| Administrative Sex | Male |
| Patient Address | 543 Blount Drive Bozeman MT 59715 USA |
| Local Number | (406)555-7690 |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 04/15/2015 |
| Publicity Code | Recall only - no calls |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Maria Elizabeth Richardson |
| Relationship | Mother |
| Address | 543 Blount Drive Bozeman MT 59715 USA |
| Phone Number | (406)555-7690 |
| Element | Data |
|---|---|
| Name | John William Richardson |
| Relationship | Father |
| Address | 543 Blount Drive Bozeman MT 59715 USA |
| Phone Number | (406)555-8299 |
| Element | Data |
|---|---|
| Administered Code | Pentacel |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 526434 |
| Substance Expiration Date | 07/22/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Polio VIS |
| Date Vis Presented | |
| Document Type | Hepatitis B VIS |
| Date Vis Presented | |
| Document Type | Diphtheria/Tetanus/Pertussis (DTaP) VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | RotaTeq |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 2.0 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 297961 |
| Substance Expiration Date | 09/16/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Oral |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Rotavirus VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | Prevnar 13 |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 353480 |
| Substance Expiration Date | 07/29/2015 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Pneumococcal Conjugate (PCV13) VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | Hep B, unspecified formulation |
| Date/Time Start of Administration | 04/16/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Administered Code | Hep B, unspecified formulation |
| Date/Time Start of Administration | 05/15/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Russell Clint Richardson |
| Mother's Maiden Name | Billington |
| ID Number | 3123 |
| Date/Time of Birth | 04/15/2015 |
| Administrative Sex | Male |
| Patient Address | 543 Blount Drive Bozeman MT 59715 USA |
| Local Number | (406)555-7690 |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 04/15/2015 |
| Publicity Code | Recall only - no calls |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Maria Elizabeth Richardson |
| Relationship | Mother |
| Address | 543 Blount Drive Bozeman MT 59715 USA |
| Phone Number | (406)555-7690 |
| Element | Data |
|---|---|
| Name | John William Richardson |
| Relationship | Father |
| Address | 543 Blount Drive Bozeman MT 59715 USA |
| Phone Number | (406)555-8299 |
| Element | Data |
|---|---|
| Administered Code | Pentacel |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 526434 |
| Substance Expiration Date | 07/22/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Polio VIS |
| Date Vis Presented | |
| Document Type | Hepatitis B VIS |
| Date Vis Presented | |
| Document Type | Diphtheria/Tetanus/Pertussis (DTaP) VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | RotaTeq |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 2.0 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 297961 |
| Substance Expiration Date | 09/16/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Oral |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Rotavirus VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | Prevnar 13 |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 353480 |
| Substance Expiration Date | 07/29/2015 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Pneumococcal Conjugate (PCV13) VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | Hep B, unspecified formulation |
| Date/Time Start of Administration | 04/16/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Administered Code | Hep B, unspecified formulation |
| Date/Time Start of Administration | 05/15/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| No Comments |
| A VXU message is generated by the EHR. |
| No PostCondition |
| No Test Objectives |
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624073734.034-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 23628 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 12462 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624073734.034-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 23628 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 12462 |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-1 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| An adult is seen at a clinic. Historical vaccinations are recorded and new vaccines are administered and documented. |
| No Comments |
| No PreCondition |
| No PostCondition |
| This test case assesses the ability of the EHR to create an administration message for an adult containing historical and new administrations including VIS and not eligible VFC. |
| No evaluation criteria |
| No Note |
A 32 year old female, Elise Wong, visits the West Clinic for a well woman visit. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient’s vaccination history and determines that Elise has received her influenza vaccinations on 10/12/2014 and 11/12/2013, but is in need of a tetanus booster. Because of the patient’s age she does not qualify for Vaccine For Children (VFC) supplied vaccine. Elise is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, she agrees to receive the recommended vaccination. She also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Tdap (TENIVAC) is selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624084727.655-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 72268 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 90012 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Wong | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Elise | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | ||
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19830615 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2028-9 | |
| PID.10.2 | Text | Asian | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 9200 Wellington Trail | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5557896 | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | NET | |
| PID.13.3 | Telecommunication Equipment Type | ||
| PID.13.4 | Email Address | Elise.Wong@isp.com | |
| PID.13.6 | Area/City Code | ||
| PID.13.7 | Local Number | ||
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | N | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 19830615 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 4422 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 13696 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 6139 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 38760 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 7600 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 35508 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49281-0215-88 | |
| RXA.5.2 | Text | TENIVAC | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 315841 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151216 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20141012 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 88 | |
| RXA.5.2 | Text | influenza, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131112 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 88 | |
| RXA.5.2 | Text | influenza, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300028811150224 | |
| OBX.5.2 | Text | Tetanus/Diphtheria (Td) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624084727.655-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 72268 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 90012 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Wong | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Elise | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | ||
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19830615 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2028-9 | |
| PID.10.2 | Text | Asian | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 9200 Wellington Trail | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5557896 | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | NET | |
| PID.13.3 | Telecommunication Equipment Type | ||
| PID.13.4 | Email Address | Elise.Wong@isp.com | |
| PID.13.6 | Area/City Code | ||
| PID.13.7 | Local Number | ||
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | N | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 19830615 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 4422 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 13696 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 6139 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 38760 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 7600 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 35508 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49281-0215-88 | |
| RXA.5.2 | Text | TENIVAC | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 315841 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151216 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20141012 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 88 | |
| RXA.5.2 | Text | influenza, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131112 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 88 | |
| RXA.5.2 | Text | influenza, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300028811150224 | |
| OBX.5.2 | Text | Tetanus/Diphtheria (Td) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Elise Wong |
| Mother's Maiden Name | |
| ID Number | 90012 |
| Date/Time of Birth | 06/15/1983 |
| Administrative Sex | Female |
| Patient Address | 9200 Wellington Trail Bozeman MT 59715 USA |
| Local Number | (406)555-7896 |
| Elise.Wong@isp.com | |
| Race | Asian |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/15/1983 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | TENIVAC |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 315841 |
| Substance Expiration Date | 12/16/2015 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Tetanus/Diphtheria (Td) VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | influenza, unspecified formulation |
| Date/Time Start of Administration | 10/12/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Administered Code | influenza, unspecified formulation |
| Date/Time Start of Administration | 11/12/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Elise Wong |
| Mother's Maiden Name | |
| ID Number | 90012 |
| Date/Time of Birth | 06/15/1983 |
| Administrative Sex | Female |
| Patient Address | 9200 Wellington Trail Bozeman MT 59715 USA |
| Local Number | (406)555-7896 |
| Elise.Wong@isp.com | |
| Race | Asian |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/15/1983 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | TENIVAC |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 315841 |
| Substance Expiration Date | 12/16/2015 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Tetanus/Diphtheria (Td) VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | influenza, unspecified formulation |
| Date/Time Start of Administration | 10/12/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Administered Code | influenza, unspecified formulation |
| Date/Time Start of Administration | 11/12/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| No Comments |
| A VXU message is generated by the EHR. |
| No PostCondition |
No Test Objectives |
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624084727.669-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 74602 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 72268 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624084727.669-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 74602 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 72268 |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-2 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| A child is seen at a clinic. A new vaccine is administered and documented but the information is not to shared by the IIS. |
| No Comments |
| No PreCondition |
| No PostCondition |
| This test case assesses the ability of the EHR to create an administration message for a child containing a new administration but an indication that the data should not be shared. |
| No evaluation criteria |
| No Note |
An 11.5 year old female, Katherine Mackenzie Benton, is brought to the West Clinic for a third and final dose of HPV vaccine. She is accompanied by her mother Kari Michelle Benton (nee Jones). A clinic staff member collects basic patient demographic information including name, date of birth and sex. The mother is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, the mother agrees that the child should receive the HPV vaccine, but she chooses not to share the data once it is incorporated into the local IIS. A clinic provider, Wilma Thomas (physician ID 654) places an order for the vaccination. While the patient is covered by insurance, the plan does not cover this vaccination and she qualifies for Vaccine For Children (VFC) supplied vaccines under the status of VFC eligible - Underinsured. An appropriate dose of HPV (CERVARIX) is selected from the clinic’s stock of publically funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the dose to the patient and then enters the data into the EHR and transmits it to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.804-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 77732 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 89778 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Benton | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Katherine | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mackenzie | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Jones | |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20031221 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 89 West 21st Ave | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5554019 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 01 | |
| PD1.11.2 | Text | No reminder/recall | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20031221 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Benton | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Kari | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Michelle | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | MTH | |
| NK1.3.2 | Text | Mother | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 89 West 21st Ave | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5554019 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5237 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 31309 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0830-05 | |
| RXA.5.2 | Text | CERVARIX | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 795441 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151223 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC50 | |
| OBX.5.2 | Text | Public | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V05 | |
| OBX.5.2 | Text | VFC Eligible - Underinsured | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300007311110503 | |
| OBX.5.2 | Text | Human papillomavirus Vaccine (Cervarix) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.804-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 77732 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 89778 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Benton | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Katherine | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mackenzie | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Jones | |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20031221 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 89 West 21st Ave | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5554019 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 01 | |
| PD1.11.2 | Text | No reminder/recall | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20031221 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Benton | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Kari | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Michelle | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | MTH | |
| NK1.3.2 | Text | Mother | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 89 West 21st Ave | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5554019 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5237 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 31309 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0830-05 | |
| RXA.5.2 | Text | CERVARIX | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 795441 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151223 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC50 | |
| OBX.5.2 | Text | Public | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V05 | |
| OBX.5.2 | Text | VFC Eligible - Underinsured | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300007311110503 | |
| OBX.5.2 | Text | Human papillomavirus Vaccine (Cervarix) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Katherine Mackenzie Benton |
| Mother's Maiden Name | Jones |
| ID Number | 89778 |
| Date/Time of Birth | 12/21/2003 |
| Administrative Sex | Female |
| Patient Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Local Number | (406)555-4019 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/21/2003 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Kari Michelle Benton |
| Relationship | Mother |
| Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Phone Number | (406)555-4019 |
| Element | Data |
|---|---|
| Administered Code | CERVARIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 795441 |
| Substance Expiration Date | 12/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - Underinsured |
| Document Type | Human papillomavirus Vaccine (Cervarix) VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Patient Name | Katherine Mackenzie Benton |
| Mother's Maiden Name | Jones |
| ID Number | 89778 |
| Date/Time of Birth | 12/21/2003 |
| Administrative Sex | Female |
| Patient Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Local Number | (406)555-4019 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/21/2003 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Kari Michelle Benton |
| Relationship | Mother |
| Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Phone Number | (406)555-4019 |
| Element | Data |
|---|---|
| Administered Code | CERVARIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 795441 |
| Substance Expiration Date | 12/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - Underinsured |
| Document Type | Human papillomavirus Vaccine (Cervarix) VIS |
| Date Vis Presented |
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| No Comments |
| A VXU message is generated by the EHR. |
| No PostCondition |
No Test Objectives |
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.806-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 65657 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 77732 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.806-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 65657 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 77732 |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-3 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| A child is seen at a clinic. A previously documented vaccination is deleted due to user error. |
| No Comments |
| No PreCondition |
| No PostCondition |
| This test case assesses the ability of the EHR to create a delete message for a previously sent administration. |
| No evaluation criteria |
| No Note |
After administering an HPV vaccination to the 11.5 year old female Katherine Benton the clinician, Lily Jackson (ID 7824) realizes that the vaccination was documented on the incorrect patient chart. She deletes the vaccination from the patient chart and transmits the change to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.804-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 71892 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 89778 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Benton | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Katherine | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mackenzie | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Jones | |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20031221 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 89 West 21st Ave | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5554019 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 01 | |
| PD1.11.2 | Text | No reminder/recall | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20031221 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Benton | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Kari | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Michelle | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | MTH | |
| NK1.3.2 | Text | Mother | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 89 West 21st Ave | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5554019 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5237 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 31309 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0830-05 | |
| RXA.5.2 | Text | CERVARIX | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 795441 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151223 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | D |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC50 | |
| OBX.5.2 | Text | Public | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V05 | |
| OBX.5.2 | Text | VFC Eligible - Underinsured | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300007311110503 | |
| OBX.5.2 | Text | Human papillomavirus Vaccine (Cervarix) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.804-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 71892 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 89778 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Benton | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Katherine | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mackenzie | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Jones | |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20031221 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 89 West 21st Ave | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5554019 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 01 | |
| PD1.11.2 | Text | No reminder/recall | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20031221 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Benton | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Kari | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Michelle | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | MTH | |
| NK1.3.2 | Text | Mother | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 89 West 21st Ave | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5554019 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5237 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 31309 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0830-05 | |
| RXA.5.2 | Text | CERVARIX | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 795441 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151223 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | D |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC50 | |
| OBX.5.2 | Text | Public | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V05 | |
| OBX.5.2 | Text | VFC Eligible - Underinsured | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300007311110503 | |
| OBX.5.2 | Text | Human papillomavirus Vaccine (Cervarix) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Katherine Mackenzie Benton |
| Mother's Maiden Name | Jones |
| ID Number | 89778 |
| Date/Time of Birth | 12/21/2003 |
| Administrative Sex | Female |
| Patient Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Local Number | (406)555-4019 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/21/2003 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Kari Michelle Benton |
| Relationship | Mother |
| Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Phone Number | (406)555-4019 |
| Element | Data |
|---|---|
| Administered Code | CERVARIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 795441 |
| Substance Expiration Date | 12/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Delete |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - Underinsured |
| Document Type | Human papillomavirus Vaccine (Cervarix) VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Patient Name | Katherine Mackenzie Benton |
| Mother's Maiden Name | Jones |
| ID Number | 89778 |
| Date/Time of Birth | 12/21/2003 |
| Administrative Sex | Female |
| Patient Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Local Number | (406)555-4019 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/21/2003 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Kari Michelle Benton |
| Relationship | Mother |
| Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Phone Number | (406)555-4019 |
| Element | Data |
|---|---|
| Administered Code | CERVARIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 795441 |
| Substance Expiration Date | 12/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Delete |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - Underinsured |
| Document Type | Human papillomavirus Vaccine (Cervarix) VIS |
| Date Vis Presented |
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| No Comments |
| A VXU message is generated by the EHR. |
| No PostCondition |
No Test Objectives |
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.806-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 65657 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 71892 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.806-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 65657 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 71892 |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-4 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| A child is seen at a clinic. A new vaccination is administered but only a partial dose is given. |
| No Comments |
| No PreCondition |
| No PostCondition |
| This test case assesses the ability of the EHR to create an administration message for child who received a partial administration of a vaccine. |
| No evaluation criteria |
| No Note |
An 18 month old male, Daryl Andre Johnson, is brought to the West Clinic for a well child visit by his father James Terrance Johnson. Daryl’s twin brother, born 5 minutes before Daryl, was not able to make it to the clinic. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient’s vaccination history and determines that the child requires a Hep A vaccination. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The father is given the Vaccine Information Sheet (VIS) to review. After reading it, the father agrees that the child should receive the Hep A vaccine He also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Hep A (VAQTA) is selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient, however the patient moves unexpectedly during the administration and only a portion of the dose is actually administered. The clinician enters the data into the EHR as a partial administration and transmits it to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.806-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 29407 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 76511 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Johnson | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Daryl | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Andre | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20131203 | |
| PID.8 | Administrative Sex | M | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2054-5 | |
| PID.10.2 | Text | African American | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 125 Aspen Crescent | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5551807 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | Y | |
| PID.25 | Birth Order | 2 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 04 | |
| PD1.11.2 | Text | Reminder only - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20131203 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Johnson | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | James | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Terrance | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | FTH | |
| NK1.3.2 | Text | Father | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 125 Aspen Crescent | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5551807 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 773 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 22119 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4095-01 | |
| RXA.5.2 | Text | VAQTA | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 68736 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150729 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | PA | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.806-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 29407 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 76511 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Johnson | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Daryl | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Andre | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20131203 | |
| PID.8 | Administrative Sex | M | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2054-5 | |
| PID.10.2 | Text | African American | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 125 Aspen Crescent | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5551807 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | Y | |
| PID.25 | Birth Order | 2 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 04 | |
| PD1.11.2 | Text | Reminder only - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20131203 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Johnson | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | James | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Terrance | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | FTH | |
| NK1.3.2 | Text | Father | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 125 Aspen Crescent | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5551807 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 773 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 22119 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4095-01 | |
| RXA.5.2 | Text | VAQTA | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 68736 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150729 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | PA | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Daryl Andre Johnson |
| Mother's Maiden Name | |
| ID Number | 76511 |
| Date/Time of Birth | 12/03/2013 |
| Administrative Sex | Male |
| Patient Address | 125 Aspen Crescent Bozeman MT 59715 USA |
| Local Number | (406)555-1807 |
| Race | African American |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/03/2013 |
| Publicity Code | Reminder only - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | James Terrance Johnson |
| Relationship | Father |
| Address | 125 Aspen Crescent Bozeman MT 59715 USA |
| Phone Number | (406)555-1807 |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 68736 |
| Substance Expiration Date | 07/29/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | PA |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Patient Name | Daryl Andre Johnson |
| Mother's Maiden Name | |
| ID Number | 76511 |
| Date/Time of Birth | 12/03/2013 |
| Administrative Sex | Male |
| Patient Address | 125 Aspen Crescent Bozeman MT 59715 USA |
| Local Number | (406)555-1807 |
| Race | African American |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/03/2013 |
| Publicity Code | Reminder only - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | James Terrance Johnson |
| Relationship | Father |
| Address | 125 Aspen Crescent Bozeman MT 59715 USA |
| Phone Number | (406)555-1807 |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 68736 |
| Substance Expiration Date | 07/29/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | PA |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented |
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| No Comments |
| A VXU message is generated by the EHR. |
| No PostCondition |
No Test Objectives |
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.807-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 51291 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 29407 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.807-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 51291 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 29407 |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-5 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| A child is seen at a clinic. A new vaccinations are administered but an additional one is refused by the parents. |
| No Comments |
| No PreCondition |
| No PostCondition |
| This test case assesses the ability of the EHR to create an administration message for child whose parents have refused an immunization. |
| No evaluation criteria |
| No Note |
A 1 year old male, Tyler Owen Banks, is brought to the West Clinic for a well child visit. He is accompanied by his father Karl Leonard Banks. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Joe Smith (physician ID 123) reviews the patient’s vaccination history and determines that the child requires Hib, Hep A, MMR and Varicella vaccinations. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The father is given the appropriate Vaccine Information Sheets (VIS) to review. After reading them, the father agrees that the child should receive the Hib, Hep A and MMR vaccines but refuses the Varicella vaccine. He also agrees that the data should be shared once it is incorporated into the local IIS. Appropriate doses of Hib (HIBERIX), Hep A (VAQTA) and MMR (M-M-R II) are selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 456) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.808-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 18019 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 8891 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Banks | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Tyler | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Owen | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20140602 | |
| PID.8 | Administrative Sex | M | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 924 Sycamore Lane | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5555835 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | N | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20040602 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Banks | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Karl | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Leonard | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | FTH | |
| NK1.3.2 | Text | Father | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 924 Sycamore Lane | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5555835 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5645 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 22515 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5027 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 12128 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 7239 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 50588 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0806-01 | |
| RXA.5.2 | Text | HIBERIX | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 328734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150923 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4095-01 | |
| RXA.5.2 | Text | VAQTA | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 208940 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20160120 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4681-01 | |
| RXA.5.2 | Text | M-M-R II | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 134301 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151028 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 21 | |
| RXA.5.2 | Text | varicella | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | 00 | |
| RXA.18.2 | Text | Parental decision | |
| RXA.18.3 | Name of Coding System | NIP002 | |
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | RE | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.808-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 18019 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 8891 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Banks | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Tyler | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Owen | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20140602 | |
| PID.8 | Administrative Sex | M | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 924 Sycamore Lane | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5555835 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | N | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20040602 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Banks | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Karl | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Leonard | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | FTH | |
| NK1.3.2 | Text | Father | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 924 Sycamore Lane | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5555835 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5645 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 22515 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5027 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 12128 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 7239 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 50588 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0806-01 | |
| RXA.5.2 | Text | HIBERIX | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 328734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150923 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4095-01 | |
| RXA.5.2 | Text | VAQTA | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 208940 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20160120 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4681-01 | |
| RXA.5.2 | Text | M-M-R II | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 134301 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151028 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 21 | |
| RXA.5.2 | Text | varicella | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | 00 | |
| RXA.18.2 | Text | Parental decision | |
| RXA.18.3 | Name of Coding System | NIP002 | |
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | RE | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Tyler Owen Banks |
| Mother's Maiden Name | |
| ID Number | 8891 |
| Date/Time of Birth | 06/02/2014 |
| Administrative Sex | Male |
| Patient Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Local Number | (406)555-5835 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/02/2004 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Karl Leonard Banks |
| Relationship | Father |
| Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Phone Number | (406)555-5835 |
| Element | Data |
|---|---|
| Administered Code | HIBERIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 328734 |
| Substance Expiration Date | 09/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Multiple Vaccines VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 208940 |
| Substance Expiration Date | 01/20/2016 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | M-M-R II |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 134301 |
| Substance Expiration Date | 10/28/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Measles/Mumps/Rubella VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | varicella |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Tyler Owen Banks |
| Mother's Maiden Name | |
| ID Number | 8891 |
| Date/Time of Birth | 06/02/2014 |
| Administrative Sex | Male |
| Patient Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Local Number | (406)555-5835 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/02/2004 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Karl Leonard Banks |
| Relationship | Father |
| Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Phone Number | (406)555-5835 |
| Element | Data |
|---|---|
| Administered Code | HIBERIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 328734 |
| Substance Expiration Date | 09/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Multiple Vaccines VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 208940 |
| Substance Expiration Date | 01/20/2016 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | M-M-R II |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 134301 |
| Substance Expiration Date | 10/28/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Measles/Mumps/Rubella VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | varicella |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| No Comments |
| A VXU message is generated by the EHR. |
| No PostCondition |
No Test Objectives |
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.822-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 79946 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 18019 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.822-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 79946 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 18019 |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-6 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| A child is seen at a clinic. A previously documented vaccination is updated to correct inaccurate information.. |
| No Comments |
| No PreCondition |
| No PostCondition |
| This test case asses the ability of the EHR to create an update message for a previously sent administration. |
| No evaluation criteria |
| No Note |
After document vaccinations for Tyler Owen Banks the clinician, Lily Jackson (ID 456) recognizes that an error was made during data entry for the Hepatitis A vaccine. The Lot Number was entered incorrectly. She updates the data in the EHR and transmits it to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.808-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 18019 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 8891 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Banks | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Tyler | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Owen | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20140602 | |
| PID.8 | Administrative Sex | M | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 924 Sycamore Lane | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5555835 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20040602 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Banks | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Karl | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Leonard | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | FTH | |
| NK1.3.2 | Text | Father | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 924 Sycamore Lane | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5555835 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5027 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 12128 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4095-01 | |
| RXA.5.2 | Text | VAQTA | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 208490 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20160120 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | U |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300004211111025 | |
| OBX.5.2 | Text | Hepatitis A VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.808-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 18019 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 8891 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Banks | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Tyler | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Owen | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20140602 | |
| PID.8 | Administrative Sex | M | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 924 Sycamore Lane | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5555835 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150624 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20040602 | |
| PD1.18 | Publicity Code Effective Date | 20150624 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Banks | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Karl | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Leonard | |
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | FTH | |
| NK1.3.2 | Text | Father | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 924 Sycamore Lane | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5555835 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 5027 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 12128 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150624 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4095-01 | |
| RXA.5.2 | Text | VAQTA | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 208490 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20160120 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | U |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300004211111025 | |
| OBX.5.2 | Text | Hepatitis A VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150624 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150624 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Tyler Owen Banks |
| Mother's Maiden Name | |
| ID Number | 8891 |
| Date/Time of Birth | 06/02/2014 |
| Administrative Sex | Male |
| Patient Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Local Number | (406)555-5835 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/02/2004 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Karl Leonard Banks |
| Relationship | Father |
| Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Phone Number | (406)555-5835 |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 208490 |
| Substance Expiration Date | 01/20/2016 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Update |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Patient Name | Tyler Owen Banks |
| Mother's Maiden Name | |
| ID Number | 8891 |
| Date/Time of Birth | 06/02/2014 |
| Administrative Sex | Male |
| Patient Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Local Number | (406)555-5835 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/02/2004 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Karl Leonard Banks |
| Relationship | Father |
| Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Phone Number | (406)555-5835 |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 208490 |
| Substance Expiration Date | 01/20/2016 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Update |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented |
| The IIS returns an acknowledgement message indicating that a fatal error was found during the course of processing the message. |
| No Comments |
| A VXU message is generated by the EHR. |
No PostCondition |
No Test Objectives |
The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.822-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 79946 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 18019 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150624093847.822-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 79946 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 18019 |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-7 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| A patient is seen at a clinic. A historical vaccination is recorded but the IIS is unable to process the administration message, rejects it and returns a fatal error in the acknowledgement message. |
| No Comments |
| No PreCondition |
| The returned error must be visible in the EHR. |
| This test case assesses the ability of the EHR to accept an acknowledgement message with a fatal error being returned by the IIS. |
| No evaluation criteria |
| No Note |
A 66 year old female, Helen Barrett, comes to the West Clinic for a physical. A clinic staff member collects basic patient demographic information including name, date of birth and sex. The patient reports that she received a Zoster vaccination at a local pharmacy on her 65th birthday. The clinic staff determine that no further vaccinations are required. A clinician, Lily Jackson (ID 7824) enters the historical data into the EHR and transmits it to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625121047.839-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 35560 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 7120 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Barrett | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Helen | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | ||
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19500317 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 763 Main St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5554064 | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | NET | |
| PID.13.3 | Telecommunication Equipment Type | ||
| PID.13.4 | Email Address | Helen.Barrett@isp.com | |
| PID.13.6 | Area/City Code | ||
| PID.13.7 | Local Number | ||
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 06 | |
| PD1.11.2 | Text | Recall only - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150625 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 19500317 | |
| PD1.18 | Publicity Code Effective Date | 20150625 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 7646 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 53100 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150317 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 121 | |
| RXA.5.2 | Text | zoster | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625121047.839-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 35560 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 7120 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Barrett | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Helen | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | ||
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19500317 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 763 Main St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5554064 | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | NET | |
| PID.13.3 | Telecommunication Equipment Type | ||
| PID.13.4 | Email Address | Helen.Barrett@isp.com | |
| PID.13.6 | Area/City Code | ||
| PID.13.7 | Local Number | ||
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 06 | |
| PD1.11.2 | Text | Recall only - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150625 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 19500317 | |
| PD1.18 | Publicity Code Effective Date | 20150625 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 7646 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 53100 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150317 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 121 | |
| RXA.5.2 | Text | zoster | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Element | Data |
|---|---|
| Patient Name | Helen Barrett |
| Mother's Maiden Name | |
| ID Number | 7120 |
| Date/Time of Birth | 03/17/1950 |
| Administrative Sex | Female |
| Patient Address | 763 Main St Bozeman MT 59715 USA |
| Local Number | (406)555-4064 |
| Helen.Barrett@isp.com | |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 03/17/1950 |
| Publicity Code | Recall only - any method |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | zoster |
| Date/Time Start of Administration | 03/17/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Helen Barrett |
| Mother's Maiden Name | |
| ID Number | 7120 |
| Date/Time of Birth | 03/17/1950 |
| Administrative Sex | Female |
| Patient Address | 763 Main St Bozeman MT 59715 USA |
| Local Number | (406)555-4064 |
| Helen.Barrett@isp.com | |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 03/17/1950 |
| Publicity Code | Recall only - any method |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | zoster |
| Date/Time Start of Administration | 03/17/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| The IIS has a mapping error in their CVX table and is unable to recognize the CVX code sent in RXA-5 even though it is valid. The IIS is unable to identify the appropriate vaccine, which is a required element, and rejects the message. The acknowledgement message returned contains errors for the table mapping, missing required field (RXA-5) and missing required segment (RXA). |
| No Comments |
| A VXU message is generated by the EHR. |
| No PostCondition |
| No Test Objectives |
| The errors returned in the ACK message must be visible in the EHR. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625121047.853-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 20428 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AE | |
| MSA.2 | Message Control ID | 35560 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | RXA | |
| ERR.2.2 | Segment Sequence | 1 | |
| ERR.2.3 | Field Position | 5 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | 1 | |
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 999 | |
| ERR.3.2 | Text | Application error | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | E | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | 5 | |
| ERR.5.2 | Text | Table value not found | |
| ERR.5.3 | Name of Coding System | HL70533 | |
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Vaccine code not recognized - message rejected |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625121047.853-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 20428 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AE | |
| MSA.2 | Message Control ID | 35560 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | RXA | |
| ERR.2.2 | Segment Sequence | 1 | |
| ERR.2.3 | Field Position | 5 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | 1 | |
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 999 | |
| ERR.3.2 | Text | Application error | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | E | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | 5 | |
| ERR.5.2 | Text | Table value not found | |
| ERR.5.3 | Name of Coding System | HL70533 | |
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Vaccine code not recognized - message rejected |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-8 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system. |
| A patient is seen at a clinic. A new administration is recorded. The IIS is able to process the administration message but finds a soft error (warning) which it returns in the acknowledgement message. |
| No Comments |
| No PreCondition |
| The returned error must be visible in the EHR. |
| This test case assesses the ability of the EHR to accept an acknowledgement message with a soft warning error being returned by the IIS. |
| No evaluation criteria |
| No Note |
A 1 month old female, Ashley Jennifer Broadbent, is brought to the West Clinic for a well child visit by her mother Ellen Broadbent (nee Layton). A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient’s vaccination history and determines that the child requires a Hep B vaccination. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The mother is given the Vaccine Information Sheet (VIS) to review. After reading it, she agrees that the child should receive the Hep B vaccine. She also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Hep B (ENGERIX-B) is selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and enters the data into the EHR and transmits it to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625103328.757-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 81883 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 77100 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Broadbent | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Ashley | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Jennifer | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Layton | |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20150516 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2054-5 | |
| PID.10.2 | Text | African American | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 901 North 12th St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5552262 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 03 | |
| PD1.11.2 | Text | Reminder/recall - no calls | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | N | |
| PD1.13 | Protection Indicator Effective Date | 20150625 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20150516 | |
| PD1.18 | Publicity Code Effective Date | 20150625 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Broadbent | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Ellen | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | ||
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | MTH | |
| NK1.3.2 | Text | Mother | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 901 North 12th St | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5552262 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 3881 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 13926 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150625 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0820-01 | |
| RXA.5.2 | Text | ENGERIX-B | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 797397 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151203 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300005911120202 | |
| OBX.5.2 | Text | Hepatitis B VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150625 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625103328.757-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 81883 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 77100 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Broadbent | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Ashley | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Jennifer | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Layton | |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20150516 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2054-5 | |
| PID.10.2 | Text | African American | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 901 North 12th St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5552262 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 03 | |
| PD1.11.2 | Text | Reminder/recall - no calls | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | N | |
| PD1.13 | Protection Indicator Effective Date | 20150625 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20150516 | |
| PD1.18 | Publicity Code Effective Date | 20150625 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Broadbent | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Ellen | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | ||
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | MTH | |
| NK1.3.2 | Text | Mother | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 901 North 12th St | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5552262 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 3881 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 13926 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150625 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0820-01 | |
| RXA.5.2 | Text | ENGERIX-B | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 797397 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151203 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300005911120202 | |
| OBX.5.2 | Text | Hepatitis B VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150625 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Ashley Jennifer Broadbent |
| Mother's Maiden Name | Layton |
| ID Number | 77100 |
| Date/Time of Birth | 05/16/2015 |
| Administrative Sex | Female |
| Patient Address | 901 North 12th St Bozeman MT 59715 USA |
| Local Number | (406)555-2262 |
| Race | African American |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 05/16/2015 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Name | Ellen Broadbent |
| Relationship | Mother |
| Address | 901 North 12th St Bozeman MT 59715 USA |
| Phone Number | (406)555-2262 |
| Element | Data |
|---|---|
| Administered Code | ENGERIX-B |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 797397 |
| Substance Expiration Date | 12/03/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis B VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Patient Name | Ashley Jennifer Broadbent |
| Mother's Maiden Name | Layton |
| ID Number | 77100 |
| Date/Time of Birth | 05/16/2015 |
| Administrative Sex | Female |
| Patient Address | 901 North 12th St Bozeman MT 59715 USA |
| Local Number | (406)555-2262 |
| Race | African American |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 05/16/2015 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Name | Ellen Broadbent |
| Relationship | Mother |
| Address | 901 North 12th St Bozeman MT 59715 USA |
| Phone Number | (406)555-2262 |
| Element | Data |
|---|---|
| Administered Code | ENGERIX-B |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 797397 |
| Substance Expiration Date | 12/03/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis B VIS |
| Date Vis Presented |
| A mapping error in the IIS software results in the IIS being unable to recognize the administration site sent in RXR-2 even though it is valid. The acknowledgement message returned contains a warning for an invalid value. |
| No Comments |
| A VXU message is generated by the EHR. |
| No PostCondition |
| No Test Objectives |
The error returned in the acknowledgement message is visible in the system responsible for the content of the administration message. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625103328.758-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 23842 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AE | |
| MSA.2 | Message Control ID | 81883 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | RXR | |
| ERR.2.2 | Segment Sequence | 2 | |
| ERR.2.3 | Field Position | 1 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | ||
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 999 | |
| ERR.3.2 | Text | Application error | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | W | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | 5 | |
| ERR.5.2 | Text | Table value not found | |
| ERR.5.3 | Name of Coding System | HL70533 | |
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Administration Site not recognized - site data will not be saved |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625103328.758-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 23842 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AE | |
| MSA.2 | Message Control ID | 81883 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | RXR | |
| ERR.2.2 | Segment Sequence | 2 | |
| ERR.2.3 | Field Position | 1 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | ||
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 999 | |
| ERR.3.2 | Text | Application error | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | W | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | 5 | |
| ERR.5.2 | Text | Table value not found | |
| ERR.5.3 | Name of Coding System | HL70533 | |
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Administration Site not recognized - site data will not be saved |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-9 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system. |
| A patient is seen at a clinic. A new administration is recorded. The IIS is able to process the administration message but finds multiple soft errors (warnings) which it returns in the acknowledgement message. |
| No Comments |
| No PreCondition |
| The returned error must be visible in the EHR. |
| This test case assesses the ability of the EHR to accept an acknowledgement message with multiple soft errors being returned by the IIS. |
| No evaluation criteria |
| No Note |
A 4 year old female, Lacy Wells, is brought to the West Clinic for a well child visit by her guardian Janelle Trudeau. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient’s vaccination history and determines that the child requires DTaP, polio, MMR and varicella vaccinations. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The guardian is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, she agrees that the child should receive all the vaccines. She also agrees that the data should be shared once it is incorporated into the local IIS. Appropriate doses of DTap-IPV (KINRIX) and MMRV (ProQuad) are selected from the clinic’s stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and enters the data into the EHR and transmits it to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625115038.030-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 10746 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 22533 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Wells | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Lacy | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | ||
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20110430 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 12 North Oak St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5552914 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 01 | |
| PD1.11.2 | Text | No reminder/recall | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150625 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20110430 | |
| PD1.18 | Publicity Code Effective Date | 20150625 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Trudeau | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Janelle | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | ||
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | GRD | |
| NK1.3.2 | Text | Guardian | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 12 North Oak St | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5552914 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 657 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 68544 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 7553 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 8671 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150625 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4171-01 | |
| RXA.5.2 | Text | ProQuad | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 407453 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151015 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150625 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0812-01 | |
| RXA.5.2 | Text | KINRIX | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 88402 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150730 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300013411100521 | |
| OBX.5.2 | Text | Measles/Mumps/Rubella/Varicella VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150625 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300017211111108 | |
| OBX.5.2 | Text | Polio VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150625 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 20150625 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625115038.030-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 10746 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 22533 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Wells | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Lacy | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | ||
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 20110430 | |
| PID.8 | Administrative Sex | F | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 12 North Oak St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5552914 | |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2186-5 | |
| PID.22.2 | Text | Not Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 01 | |
| PD1.11.2 | Text | No reminder/recall | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | Y | |
| PD1.13 | Protection Indicator Effective Date | 20150625 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20110430 | |
| PD1.18 | Publicity Code Effective Date | 20150625 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Trudeau | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Janelle | |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | ||
| NK1.2.7 | Name Type Code | L | |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | GRD | |
| NK1.3.2 | Text | Guardian | |
| NK1.3.3 | Name of Coding System | HL70063 | |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 12 North Oak St | |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Bozeman | |
| NK1.4.4 | State or Province | MT | |
| NK1.4.5 | Zip or Postal Code | 59715 | |
| NK1.4.6 | Country | USA | |
| NK1.4.7 | Address Type | P | |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | |
| NK1.5.3 | Telecommunication Equipment Type | PH | |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 406 | |
| NK1.5.7 | Local Number | 5552914 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 657 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 68544 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 7553 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 8671 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | 654 | |
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Thomas | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Wilma | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | |
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | wcEHR | |
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | MD | |
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150625 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 00006-4171-01 | |
| RXA.5.2 | Text | ProQuad | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 407453 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20151015 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck and Co., Inc. | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150625 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 58160-0812-01 | |
| RXA.5.2 | Text | KINRIX | |
| RXA.5.3 | Name of Coding System | NDC | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | mL | |
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New Record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | 7824 | |
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Jackson | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lily | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | wcEHR | |
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | L | |
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | PRN | |
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | wcEHR | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 88402 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150730 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | Intramuscular | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300013411100521 | |
| OBX.5.2 | Text | Measles/Mumps/Rubella/Varicella VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150625 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30963-3 | |
| OBX.3.2 | Text | Vaccine Funding Source | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | PHC70 | |
| OBX.5.2 | Text | Private | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | Vaccine Funding Program Eligibility | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC Eligible | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | VXC40 | |
| OBX.17.2 | Text | per immunization | |
| OBX.17.3 | Name of Coding System | CDCPHINVS | |
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300017211111108 | |
| OBX.5.2 | Text | Polio VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 20150625 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document Type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | Date Vis Presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | 20150625 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150625 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Lacy Wells |
| Mother's Maiden Name | |
| ID Number | 22533 |
| Date/Time of Birth | 04/30/2011 |
| Administrative Sex | Female |
| Patient Address | 12 North Oak St Bozeman MT 59715 USA |
| Local Number | (406)555-2914 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 04/30/2011 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Name | Janelle Trudeau |
| Relationship | Guardian |
| Address | 12 North Oak St Bozeman MT 59715 USA |
| Phone Number | (406)555-2914 |
| Element | Data |
|---|---|
| Administered Code | ProQuad |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 407453 |
| Substance Expiration Date | 10/15/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Measles/Mumps/Rubella/Varicella VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | KINRIX |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 88402 |
| Substance Expiration Date | 07/30/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Polio VIS |
| Date Vis Presented | |
| Document Type | Diphtheria/Tetanus/Pertussis (DTaP) VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Patient Name | Lacy Wells |
| Mother's Maiden Name | |
| ID Number | 22533 |
| Date/Time of Birth | 04/30/2011 |
| Administrative Sex | Female |
| Patient Address | 12 North Oak St Bozeman MT 59715 USA |
| Local Number | (406)555-2914 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 04/30/2011 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Name | Janelle Trudeau |
| Relationship | Guardian |
| Address | 12 North Oak St Bozeman MT 59715 USA |
| Phone Number | (406)555-2914 |
| Element | Data |
|---|---|
| Administered Code | ProQuad |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 407453 |
| Substance Expiration Date | 10/15/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Measles/Mumps/Rubella/Varicella VIS |
| Date Vis Presented |
| Element | Data |
|---|---|
| Administered Code | KINRIX |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 88402 |
| Substance Expiration Date | 07/30/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Polio VIS |
| Date Vis Presented | |
| Document Type | Diphtheria/Tetanus/Pertussis (DTaP) VIS |
| Date Vis Presented |
| A mapping error in the IIS software results in the IIS being unable to recognize either administration site sent in RXR-2 even though it is valid. The acknowledgement message returned contains warnings for the invalid values. |
| No Comments |
| A VXU message is generated by the EHR. |
| No PostCondition |
| No Test Objectives |
The errors returned in the acknowledgement message are visible in the system responsible for the content of the administration message. |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625115038.044-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 29540 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AE | |
| MSA.2 | Message Control ID | 10746 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | RXR | |
| ERR.2.2 | Segment Sequence | 1 | |
| ERR.2.3 | Field Position | 2 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | 1 | |
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 999 | |
| ERR.3.2 | Text | Application error | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | W | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | 5 | |
| ERR.5.2 | Text | Table value not found | |
| ERR.5.3 | Name of Coding System | HL70533 | |
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Administration Site not recognized - site data will not be saved |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | RXR | |
| ERR.2.2 | Segment Sequence | 2 | |
| ERR.2.3 | Field Position | 2 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | 1 | |
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 999 | |
| ERR.3.2 | Text | Application error | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | W | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | 5 | |
| ERR.5.2 | Text | Table value not found | |
| ERR.5.3 | Name of Coding System | HL70533 | |
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Administration Site not recognized - site data will not be saved |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625115038.044-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 29540 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AE | |
| MSA.2 | Message Control ID | 10746 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | RXR | |
| ERR.2.2 | Segment Sequence | 1 | |
| ERR.2.3 | Field Position | 2 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | 1 | |
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 999 | |
| ERR.3.2 | Text | Application error | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | W | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | 5 | |
| ERR.5.2 | Text | Table value not found | |
| ERR.5.3 | Name of Coding System | HL70533 | |
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Administration Site not recognized - site data will not be saved |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | RXR | |
| ERR.2.2 | Segment Sequence | 2 | |
| ERR.2.3 | Field Position | 2 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | 1 | |
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 999 | |
| ERR.3.2 | Text | Application error | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | W | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | 5 | |
| ERR.5.2 | Text | Table value not found | |
| ERR.5.3 | Name of Coding System | HL70533 | |
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Administration Site not recognized - site data will not be saved |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-10 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system. |
| A patient is seen at a clinic. A historical vaccination is recorded but the IIS is unable to process the administration message, rejects it and returns a fatal error in the?acknowledgement?message. |
| No Comments |
| No PreCondition |
| The returned error must be visible in the EHR. |
| This test case assesses the ability of the EHR to accept an acknowledgement message with a fatal system error being returned by the IIS. |
| No evaluation criteria |
| No Note |
A 68 year old male, Manuel Diego Vasquez, comes to the West Clinic for a physical. A clinic staff member collects basic patient demographic information including name, date of birth and sex. The patient reports that he received a pneumococcal vaccination at a local pharmacy on October 21, 2014. The clinic staff determine that no further vaccinations are required. A clinician, Lily Jackson (ID 7824) enters the historical data into the EHR and transmits it to the IIS. |
No Comments |
No PreCondition |
No PostCondition |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625072816.601-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 41821 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 21142 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Vasquez | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Manuel | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Diego | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19470215 | |
| PID.8 | Administrative Sex | M | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 227 Park Ave | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5555815 | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | NET | |
| PID.13.3 | Telecommunication Equipment Type | ||
| PID.13.4 | Email Address | Manuel.Vasquez@isp.com | |
| PID.13.6 | Area/City Code | ||
| PID.13.7 | Local Number | ||
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | |
| PID.22.2 | Text | Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 01 | |
| PD1.11.2 | Text | No reminder/recall | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | N | |
| PD1.13 | Protection Indicator Effective Date | 20150625 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20150625 | |
| PD1.18 | Publicity Code Effective Date | 20150625 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 4486 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 31165 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20141021 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 152 | |
| RXA.5.2 | Text | Pneumococcal Conjugate, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | wcEHR | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | IIS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625072816.601-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | 41821 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | wcEHR | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | IIS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 21142 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | wcEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Vasquez | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Manuel | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Diego | |
| PID.5.7 | Name Type Code | L | |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | ||
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | ||
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19470215 | |
| PID.8 | Administrative Sex | M | |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2106-3 | |
| PID.10.2 | Text | White | |
| PID.10.3 | Name of Coding System | CDCREC | |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 227 Park Ave | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Bozeman | |
| PID.11.4 | State or Province | MT | |
| PID.11.5 | Zip or Postal Code | 59715 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | P | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | |
| PID.13.3 | Telecommunication Equipment Type | PH | |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 406 | |
| PID.13.7 | Local Number | 5555815 | |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | NET | |
| PID.13.3 | Telecommunication Equipment Type | ||
| PID.13.4 | Email Address | Manuel.Vasquez@isp.com | |
| PID.13.6 | Area/City Code | ||
| PID.13.7 | Local Number | ||
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | |
| PID.22.2 | Text | Hispanic or Latino | |
| PID.22.3 | Name of Coding System | CDCREC | |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | N | |
| PID.25 | Birth Order | 1 | |
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator | N |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 01 | |
| PD1.11.2 | Text | No reminder/recall | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | N | |
| PD1.13 | Protection Indicator Effective Date | 20150625 | |
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20150625 | |
| PD1.18 | Publicity Code Effective Date | 20150625 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 4486 | |
| ORC.2.2 | Namespace ID | wcEHR | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 31165 | |
| ORC.3.2 | Namespace ID | wcEHR | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | 7824 | |
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Jackson | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lily | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | Suzanne | |
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | wcEHR | |
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | L | |
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | PRN | |
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | ||
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | ||
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | ||
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | wcEHR | |
| ORC.17.2 | Text | West Clinic | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20141021 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 152 | |
| RXA.5.2 | Text | Pneumococcal Conjugate, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Administration | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Element | Data |
|---|---|
| Patient Name | Manuel Diego Vasquez |
| Mother's Maiden Name | |
| ID Number | 21142 |
| Date/Time of Birth | 02/15/1947 |
| Administrative Sex | Male |
| Patient Address | 227 Park Ave Bozeman MT 59715 USA |
| Local Number | (406)555-5815 |
| Manuel.Vasquez@isp.com | |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/25/2015 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | Pneumococcal Conjugate, unspecified formulation |
| Date/Time Start of Administration | 10/21/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Manuel Diego Vasquez |
| Mother's Maiden Name | |
| ID Number | 21142 |
| Date/Time of Birth | 02/15/1947 |
| Administrative Sex | Male |
| Patient Address | 227 Park Ave Bozeman MT 59715 USA |
| Local Number | (406)555-5815 |
| Manuel.Vasquez@isp.com | |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/25/2015 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | Pneumococcal Conjugate, unspecified formulation |
| Date/Time Start of Administration | 10/21/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
Due to an error in the IIS software, the IIS is unable to recognize the HL7 version ID sent in MSH-12 even though it is valid. The acknowledgement message returned contains an error for an unsupported version ID. |
No Comments |
A VXU message is generated by the EHR. |
No PostCondition |
No Test Objectives |
The error returned in the acknowledgement message is visible in the system responsible for the content of the administration message. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625072816.602-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 48026 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AR | |
| MSA.2 | Message Control ID | 41821 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | MSH | |
| ERR.2.2 | Segment Sequence | 12 | |
| ERR.2.3 | Field Position | 1 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | ||
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 203 | |
| ERR.3.2 | Text | Unsupported Version ID | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | E | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | ||
| ERR.5.2 | Text | ||
| ERR.5.3 | Name of Coding System | ||
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Version ID not recognized - message rejected |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | ||
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | IIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | wcEHR | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150625072816.602-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | 48026 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | IIS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | wcEHR | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AR | |
| MSA.2 | Message Control ID | 41821 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR.2 | Error Location | ||
| ERR.2.1 | Segment ID | MSH | |
| ERR.2.2 | Segment Sequence | 12 | |
| ERR.2.3 | Field Position | 1 | |
| ERR.2.4 | Field Repetition | 1 | |
| ERR.2.5 | Component Number | ||
| ERR.2.6 | Sub-Component Number | ||
| ERR.3 | HL7 Error Code | ||
| ERR.3.1 | Identifier | 203 | |
| ERR.3.2 | Text | Unsupported Version ID | |
| ERR.3.3 | Name of Coding System | HL70357 | |
| ERR.3.5 | Alternate Text | ||
| ERR.3.6 | Name of Alternate Coding System | ||
| ERR.4 | Severity | E | |
| ERR.5 | Application Error Code | ||
| ERR.5.1 | Identifier | ||
| ERR.5.2 | Text | ||
| ERR.5.3 | Name of Coding System | ||
| ERR.5.5 | Alternate Text | ||
| ERR.5.6 | Name of Alternate Coding System | ||
| ERR.8 | User Message | Version ID not recognized - message rejected |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | TC-11 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system. |
A young adult is seen by a clinician. The clinician uses the EHR to request and evaluated history and forecast. The IIS returns an evaluated history and forecast for that person. |
No Comments |
The person has a record in the IIS. |
No PostCondition |
Evaluates EHR ability to create a well formed query for a young adult. Evaluates EHR ability to accept a response with evaluated history and forecast for that person. |
No evaluation criteria |
No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyEHR | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | DCS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MyIIS | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | StatePH | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150531145156-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | QBP | |
| MSH.9.2 | Trigger Event | Q11 | |
| MSH.9.3 | Message Structure | QBP_Q11 | |
| MSH.10 | Message Control ID | 443533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z44 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 12993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Stanley | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sally | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP.1 | Query Priority | I |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyEHR | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | DCS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MyIIS | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | StatePH | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150531145156-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | QBP | |
| MSH.9.2 | Trigger Event | Q11 | |
| MSH.9.3 | Message Structure | QBP_Q11 | |
| MSH.10 | Message Control ID | 443533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z44 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 12993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Stanley | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sally | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP.1 | Query Priority | I |
| Element | Data |
|---|---|
| Patient Name | Sally S Stanley |
| Date/Time of Birth | 02/14/1980 |
| Sex | Male |
| Patient Address | 10 East Main St Pretty Valley MI |
| Patient Phone | (734)555-6712 |
| Element | Data |
|---|---|
| Patient Name | Sally S Stanley |
| Date/Time of Birth | 02/14/1980 |
| Sex | Male |
| Patient Address | 10 East Main St Pretty Valley MI |
| Patient Phone | (734)555-6712 |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MyEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150531145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 4483533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | StatePH | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | DCS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | DCS | |
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | XX | |
| MSH.23.10 | Organization Identifier | 6439432 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | Test Case Fixed |
| MSA.2 | Message Control ID | 793543 | System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | System Generated |
| QAK.2 | Query Response Status | OK | Test Case Fixed |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | request evaluated Immunization history | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 12993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Stanley | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sally | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 12993456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 34500907 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MyIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Stanley | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Sally | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | S | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19800214 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 10 East Main St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Titletown | |
| PID.11.4 | State or Province | WI | |
| PID.11.5 | Zip or Postal Code | ||
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | MyIIS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 207023 | |
| ORC.3.2 | Namespace ID | MyIIS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 227023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 317023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197024 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197025 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197026 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197028 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197029 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197123 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197223 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197323 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197423 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197523 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197623 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | ||
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 887834 | |
| ORC.2.2 | Namespace ID | MyIIS | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | ||
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | Hep B NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090515 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | Hep B NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091215 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | Hep B NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800615 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800815 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19811115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19860415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800615 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800910 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19860415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 100 | |
| RXA.5.2 | Text | PCV7 | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 139 | |
| RXA.5.2 | Text | Td NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 88 | |
| RXA.5.2 | Text | influenza NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 141 | |
| RXA.5.2 | Text | influenza seasonal | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110901 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 140 | |
| RXA.5.2 | Text | seasonal flu | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150531 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | 20150531 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | 20150531 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | 20150531 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | 20150531 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MyEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150531145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 4483533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | StatePH | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | DCS | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | DCS | |
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | XX | |
| MSH.23.10 | Organization Identifier | 6439432 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | Test Case Fixed |
| MSA.2 | Message Control ID | 793543 | System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | System Generated |
| QAK.2 | Query Response Status | OK | Test Case Fixed |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | request evaluated Immunization history | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 12993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Stanley | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sally | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 12993456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 34500907 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MyIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Stanley | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Sally | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | S | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19800214 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 10 East Main St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Titletown | |
| PID.11.4 | State or Province | WI | |
| PID.11.5 | Zip or Postal Code | ||
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | MyIIS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 207023 | |
| ORC.3.2 | Namespace ID | MyIIS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 227023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 317023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197024 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197025 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197026 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197028 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197029 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197123 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197223 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197323 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197423 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197523 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197623 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | ||
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | 887834 | |
| ORC.2.2 | Namespace ID | MyIIS | |
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | ||
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | Hep B NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090515 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | Hep B NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091215 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | Hep B NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800615 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800815 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19811115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19860415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800615 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19800910 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19860415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 100 | |
| RXA.5.2 | Text | PCV7 | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 139 | |
| RXA.5.2 | Text | Td NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 88 | |
| RXA.5.2 | Text | influenza NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 141 | |
| RXA.5.2 | Text | influenza seasonal | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110901 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 140 | |
| RXA.5.2 | Text | seasonal flu | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150531 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 16 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 17 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | 20150531 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 18 | |
| OBX.5 | Observation Value | 20150531 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | 20150531 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 19 | |
| OBX.5 | Observation Value | 20150531 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150531 |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Q R TC-1 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 12993456 | Sally S Stanley | 02/14/1980 | Female | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B NOS | Hep B NOS | 04/15/2009 | YES | Complete | ||
| Hep B NOS | Hep B NOS | 05/15/2009 | YES | Complete | ||
| Hep B NOS | Hep B NOS | 12/15/2009 | YES | Complete | ||
| DTAP NOS | DTP | 04/15/1980 | YES | Complete | ||
| DTAP NOS | DTP | 06/15/1980 | YES | Complete | ||
| DTAP NOS | DTP | 08/15/1980 | YES | Complete | ||
| DTAP NOS | DTP | 11/15/1981 | YES | Complete | ||
| DTAP NOS | DTP | 04/15/1986 | YES | Complete | ||
| polio NOS | polio NOS | 04/15/1980 | YES | Complete | ||
| polio NOS | polio NOS | 06/15/1980 | YES | Complete | ||
| polio NOS | polio NOS | 09/10/1980 | YES | Complete | ||
| polio NOS | polio NOS | 04/15/1986 | YES | Complete | ||
| pnuemococcal conjugate | PCV7 | 04/15/2010 | YES | Complete | ||
| Td NOS | Td NOS | 04/15/2010 | YES | Complete | ||
| influenza NOS | influenza NOS | 10/15/2009 | YES | Complete | ||
| influenza NOS | influenza seasonal | 10/15/2010 | YES | Complete | ||
| influenza NOS | seasonal flu | 09/01/2011 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| influenza NOS | 05/31/2015 | 05/31/2015 | ||||
| MMR | 05/31/2015 | 05/31/2015 | ||||
This test requests an evaluated history and forecast for an adult with a small pox vaccination. |
No Comments |
No PreCondition |
No PostCondition |
The objective is to evaluate the ability of the EHR to gracefully handle an immunization with no validation and not forecast. |
No evaluation criteria |
No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20141031145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | QBP | |
| MSH.9.2 | Trigger Event | Q11 | |
| MSH.9.3 | Message Structure | QBP_Q11 | |
| MSH.10 | Message Control ID | 443533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z44 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 123456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Stanley | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Clement | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Smith | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19500214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Titletown | |
| QPD.8.4 | State or Province | WI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 690 | |
| QPD.9.7 | Local Number | 1231234 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP.1 | Query Priority | I |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20141031145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | QBP | |
| MSH.9.2 | Trigger Event | Q11 | |
| MSH.9.3 | Message Structure | QBP_Q11 | |
| MSH.10 | Message Control ID | 443533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z44 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 123456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Stanley | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Clement | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Smith | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19500214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Titletown | |
| QPD.8.4 | State or Province | WI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 690 | |
| QPD.9.7 | Local Number | 1231234 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP.1 | Query Priority | I |
| Element | Data |
|---|---|
| Patient Name | Clement S Stanley |
| Date/Time of Birth | 02/14/1950 |
| Sex | Male |
| Patient Address | 10 East Main St Titletown WI |
| Patient Phone | (690)123-1234 |
| Element | Data |
|---|---|
| Patient Name | Clement S Stanley |
| Date/Time of Birth | 02/14/1950 |
| Sex | Male |
| Patient Address | 10 East Main St Titletown WI |
| Patient Phone | (690)123-1234 |
| Query is returned for Clement S Stanley. Clement has a number of historical dose records, including one for small pox. This vaccine is not validated and so has no dose validity. All other doses are valid. Mr. Stanley is due for a pneumococcal vaccine and an influenza vaccine. |
| No Comments |
| No PreCondition |
| No PostCondition |
| Deomonstrate capability to receive a response file with a number of doses adminsitered, both current and historical. Also demonstrate capability to display a vaccination that is not validated. |
| No evaluation criteria |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20141031145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 443533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | request evaluated Immunization history | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 123456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Stanley | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Clement | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Smith | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19500214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Titletown | |
| QPD.8.4 | State or Province | WI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 690 | |
| QPD.9.7 | Local Number | 1231234 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 34500907 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MyIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Stanley | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Clement | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | S | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19500214 | |
| PID.8 | Administrative Sex | M | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 10 East Main St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Titletown | |
| PID.11.4 | State or Province | WI | |
| PID.11.5 | Zip or Postal Code | ||
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 1970213 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 1197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 1972023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 1973023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19703423 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19722023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19701223 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 45197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19577023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19799023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197789023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 193337027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | ||
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 31 | |
| RXA.5.2 | Text | Hep B Peds NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090515 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 31 | |
| RXA.5.2 | Text | Hep B Peds NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091215 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 31 | |
| RXA.5.2 | Text | Hep B Peds NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19600415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19600415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19600615 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19600910 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19610415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 33 | |
| RXA.5.2 | Text | pneumococcal ppv23 | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 139 | |
| RXA.5.2 | Text | Td NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 88 | |
| RXA.5.2 | Text | influenza NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 141 | |
| RXA.5.2 | Text | influenza seasonal | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110901 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 140 | |
| RXA.5.2 | Text | seasonal flu | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Sticker | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Nurse | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20141031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | 20150214 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest Date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | 20150914 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 20150914 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | iwehwieofnd | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 20151111 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 9 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest Date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 20150914 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | ||
| RXR.2.2 | Text | ||
| RXR.2.3 | Name of Coding System | ||
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20141031145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 443533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | request evaluated Immunization history | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 123456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Stanley | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Clement | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Smith | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19500214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Titletown | |
| QPD.8.4 | State or Province | WI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 690 | |
| QPD.9.7 | Local Number | 1231234 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 34500907 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MyIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Stanley | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Clement | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | S | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 19500214 | |
| PID.8 | Administrative Sex | M | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 10 East Main St | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Titletown | |
| PID.11.4 | State or Province | WI | |
| PID.11.5 | Zip or Postal Code | ||
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 1970213 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 1197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 1972023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 1973023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19703423 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19722023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19701223 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 45197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19577023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 19799023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197789023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 193337027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | ||
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | DCS | |
| ORC.17.2 | Text | Dabig Clinical System | |
| ORC.17.3 | Name of Coding System | StateIIS | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 31 | |
| RXA.5.2 | Text | Hep B Peds NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090515 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 31 | |
| RXA.5.2 | Text | Hep B Peds NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091215 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 31 | |
| RXA.5.2 | Text | Hep B Peds NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19600415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 01 | |
| RXA.5.2 | Text | DTP | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19600415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19600615 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19600910 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 19610415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 89 | |
| RXA.5.2 | Text | polio NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20130415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 33 | |
| RXA.5.2 | Text | pneumococcal ppv23 | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20090415 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 139 | |
| RXA.5.2 | Text | Td NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 88 | |
| RXA.5.2 | Text | influenza NOS | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 141 | |
| RXA.5.2 | Text | influenza seasonal | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110901 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 140 | |
| RXA.5.2 | Text | seasonal flu | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Sticker | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Nurse | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20141031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 4 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 5 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 6 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 7 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 8 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 9 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 10 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 11 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 12 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 13 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | 20150214 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest Date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 14 | |
| OBX.5 | Observation Value | 20150914 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 20150914 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | iwehwieofnd | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 20151111 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 9 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest Date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 15 | |
| OBX.5 | Observation Value | 20150914 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | ||
| RXR.1.6 | Name of Alternate Coding System | ||
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | ||
| RXR.2.2 | Text | ||
| RXR.2.3 | Name of Coding System | ||
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Q R TC-2 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 123456 | Clement S Stanley | 02/14/1950 | Male | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B NOS | Hep B Peds NOS | 04/15/2009 | YES | Complete | ||
| Hep B NOS | Hep B Peds NOS | 05/15/2009 | YES | Complete | ||
| Hep B NOS | Hep B Peds NOS | 12/15/2009 | YES | Complete | ||
| DTAP NOS | DTP | 04/15/1960 | YES | Complete | ||
| polio NOS | polio NOS | 04/15/1960 | YES | Complete | ||
| polio NOS | polio NOS | 06/15/1960 | YES | Complete | ||
| polio NOS | polio NOS | 09/10/1960 | YES | Complete | ||
| polio NOS | polio NOS | 04/15/1961 | YES | Complete | ||
| pneumococcal ppv23 | pneumococcal ppv23 | 04/15/2013 | YES | Complete | ||
| Td NOS | Td NOS | 04/15/2009 | YES | Complete | ||
| influenza NOS | influenza NOS | 10/15/2009 | YES | Complete | ||
| influenza NOS | influenza seasonal | 10/15/2010 | YES | Complete | ||
| influenza NOS | seasonal flu | 09/01/2011 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Series Status | Forecast Reason | Tester Comment |
| pcv NOS | 02/14/2015 | 09/14/2015 | 11/11/2015 | |||
| influenza NOS | 09/14/2015 | 09/14/2015 | 11/11/2015 | |||
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | Test Case Fixed |
| MSH.2 | Encoding Characters | ^~\& | Test Case Fixed |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyEHR | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | DCS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MyIIS | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | StatePH | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150531145156-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | QBP | |
| MSH.9.2 | Trigger Event | Q11 | |
| MSH.9.3 | Message Structure | QBP_Q11 | |
| MSH.10 | Message Control ID | 993533469 | Content Indifferent |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | Test Case Fixed |
| MSH.16 | Application Acknowledgment Type | AL | Test Case Fixed |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z44 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | Content Indifferent |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 177993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Standard | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sam | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | Test Case Fixed |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP.1 | Query Priority | I |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | Test Case Fixed |
| MSH.2 | Encoding Characters | ^~\& | Test Case Fixed |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyEHR | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | DCS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MyIIS | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | StatePH | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150531145156-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | QBP | |
| MSH.9.2 | Trigger Event | Q11 | |
| MSH.9.3 | Message Structure | QBP_Q11 | |
| MSH.10 | Message Control ID | 993533469 | Content Indifferent |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | Test Case Fixed |
| MSH.16 | Application Acknowledgment Type | AL | Test Case Fixed |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z44 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | Content Indifferent |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 177993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Standard | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sam | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | Test Case Fixed |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP.1 | Query Priority | I |
| Element | Data |
|---|---|
| Patient Name | Sam S Standard |
| Date/Time of Birth | 02/14/1980 |
| Sex | Male |
| Patient Address | 10 East Main St Pretty Valley MI |
| Patient Phone | (734)555-6712 |
| Element | Data |
|---|---|
| Patient Name | Sam S Standard |
| Date/Time of Birth | 02/14/1980 |
| Sex | Male |
| Patient Address | 10 East Main St Pretty Valley MI |
| Patient Phone | (734)555-6712 |
No Description |
No Comments |
query finds no matches |
Clinician is alerted to fact of no matches. |
No Test Objectives |
Clinician is notified of no match. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20151031145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 3533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z33 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 993533469 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | NF | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | request evaluated Immunization history | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 177993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Standard | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sam | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20151031145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 3533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z33 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 993533469 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | NF | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | request evaluated Immunization history | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 177993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Standard | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sam | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Q R TC-3 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are permitted to be displayed by the EHR.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 177993456 | Sam S Standard | 02/14/1980 | Male | |
| When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query. |
This test evaluates the ability of the EHR to gracefully accept a response where too many matches are found, based on the parameters sent in the query. Note that this query only expects an evaluated history and forecast when an exact match is found. |
The intiating clinician should be alerted to the failure to get an exact match. |
No PreCondition |
No PostCondition |
The intiating clinician should be alerted to the failure to get an exact match. |
The EHR receives the response and alerts the clinician that too many matches were found. |
No Note |
This test sends a query that will find too many matches. |
The sending system will need to accept a response indicating that too many matches were found. |
More than one person in the IIS matching the parameters in the query exists. |
Response indicates that there are more than one match (too many) and the clinician is informed. |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | Test Case Fixed |
| MSH.2 | Encoding Characters | ^~\& | Test Case Fixed |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyEHR | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | DCS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MyIIS | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | StatePH | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150531145156-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | QBP | |
| MSH.9.2 | Trigger Event | Q11 | |
| MSH.9.3 | Message Structure | QBP_Q11 | |
| MSH.10 | Message Control ID | 113533469 | Content Indifferent |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | Test Case Fixed |
| MSH.16 | Application Acknowledgment Type | AL | Test Case Fixed |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z44 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 3137374859 | Content Indifferent |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 177993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Johnson | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sam | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | Test Case Fixed |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | Test Case Fixed |
| MSH.2 | Encoding Characters | ^~\& | Test Case Fixed |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyEHR | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | DCS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MyIIS | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | StatePH | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20150531145156-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | QBP | |
| MSH.9.2 | Trigger Event | Q11 | |
| MSH.9.3 | Message Structure | QBP_Q11 | |
| MSH.10 | Message Control ID | 113533469 | Content Indifferent |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | Test Case Fixed |
| MSH.16 | Application Acknowledgment Type | AL | Test Case Fixed |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z44 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 3137374859 | Content Indifferent |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 177993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Johnson | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sam | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | Test Case Fixed |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Element | Data |
|---|---|
| Patient Name | Sam S Johnson |
| Date/Time of Birth | 02/14/1980 |
| Sex | Male |
| Patient Address | 10 East Main St Pretty Valley MI |
| Patient Phone | (734)555-6712 |
| Element | Data |
|---|---|
| Patient Name | Sam S Johnson |
| Date/Time of Birth | 02/14/1980 |
| Sex | Male |
| Patient Address | 10 East Main St Pretty Valley MI |
| Patient Phone | (734)555-6712 |
No Description |
No Comments |
No PreCondition |
Clinician is alerted to multiple match condition. |
No Test Objectives |
No evaluation criteria |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20151031145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 3533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z33 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 113533469 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 3137374859 | |
| QAK.2 | Query Response Status | TM | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | request evaluated Immunization history | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 3137374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 177993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Johnson | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sam | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MyIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | StatePH | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | DCS | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20151031145233-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 3533469 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z33 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | DCS | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | DCS | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | XX | |
| MSH.22.10 | Organization Identifier | 6439432 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | StatePH | |
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 113533469 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 3137374859 | |
| QAK.2 | Query Response Status | TM | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | request evaluated Immunization history | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 3137374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | 177993456 | |
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | MYEHR | |
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | MR | |
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Johnson | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Sam | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | ||
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | ||
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 19800214 | |
| QPD.7 | Patient Sex | M | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 10 East Main St | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Pretty Valley | |
| QPD.8.4 | State or Province | MI | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 734 | |
| QPD.9.7 | Local Number | 5556712 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | Q R TC-4 | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are permitted to be displayed by the EHR.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 177993456 | Sam S Johnson | 02/14/1980 | Male | |
| When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query. |